The analysis of issues in rural health care often share common concerns, including the continuity of care, provider availability, work force issues, and geographic distance. This pilot project will seek to develop a common framework for analyzing health care issues through the application to a specific health care issue, namely child and maternal birth outcomes. The Wyoming Center for Rural Health Research & Education, in collaboration with the Western Center for Health Services Research at the National Association of Health Data Organizations (NAHDO), and four state health data agencies propose to build analytic and Geographic Information Systems (GIS) infrastructure in three Intermountain rural states and one northeast state. Using GIS methodologies, with technical assistance provided by the Western Center, Nevada, Utah, Wyoming, and Maine will collaborate in the development of a framework for evaluating the access and outcomes of maternal populations in rural states. This project will investigate how rural differences in the availability of health care providers, health insurance and the organization of health care delivery might impact child and maternal health outcomes in rural settings. In addition, the project will build infrastructure to allow further study of these similar health care questions under a common analytic framework. We will use a large database from several states to profile newborn and maternal outcomes from 1998 to 2001 in order to characterize changes in the pattern of medical use, treatment intensity and cause-of-death among rural deliveries. Results from the study will help policymakers design programs to address the unique characteristics of health care delivery in rural settings. The specific aims of this proposal are: 1. To identify differences in newborn and maternal birth outcomes across geographic areas in rural settings, and to determine whether provider access was a potential determinant of these differences 2. To develop a general framework for the analysis of rural health issues that can be applied to a wide variety of access to care issues and health outcomes 3. To develop the data and research infrastructure to conduct multi-state analyses of rural health issues.